Clonal outbreak of Candida vulturna in a paediatric oncology ward in Maranhão, Brazil

Alessandra Teixeira de Macedo; Daniel Wagner de Castro Lima Santos; Bram Spruijtenburg; Dayse Azevedo Coelho de Souza; Leila Ferreira Moreira Dos Santos Barbos; Sirlei Garcia Marques; Julliana Ribeiro Alves Dos Santos; Eelco F J Meijer; Theun de Groot; Conceição de Maria Pedrozo E Silva de Azevedo; Jacques F Meis

doi:10.1016/j.jinf.2024.106349

Clonal outbreak of Candida vulturna in a paediatric oncology ward in Maranhão, Brazil

J Infect. 2024 Nov 11:106349. doi: 10.1016/j.jinf.2024.106349. Online ahead of print.

Affiliations

¹ Universidade Federal do Maranhão (UFMA)-Programa de Pós Graduação em Ciências da Saúde, São Luís MA, Brazil.
² Instituto D'Or de Pesquisa e Ensino (IDOR), São Luís MA, Brazil; Hospital Universitário, Universidade Federal do Maranhão, São Luís MA, Brazil.
³ Radboudumc- Canisius-Wilhelmina Hospital Center of Expertise for Mycology, Nijmegen, Netherlands; Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital/Dicoon, Nijmegen, Netherlands.
⁴ Universidade Federal do Maranhão (UFMA)-Programa de Pós Graduação em Ciências da Saúde, São Luís MA, Brazil; Hospital de Cancer Aldenora Bello(HCAB), São Luís MA, Brazil.
⁵ Hospital de Cancer Aldenora Bello(HCAB), São Luís MA, Brazil.
⁶ Hospital Universitário, Universidade Federal do Maranhão, São Luís MA, Brazil; Laboratório Cedro, São Luís MA, Brazil.
⁷ Instituto de Ciências Biológicas- Universidade de Pernambuco, Recife PE, Brazil.
⁸ Radboudumc- Canisius-Wilhelmina Hospital Center of Expertise for Mycology, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital/Dicoon, Nijmegen, Netherlands.
⁹ Radboudumc- Canisius-Wilhelmina Hospital Center of Expertise for Mycology, Nijmegen, Netherlands; Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany. Electronic address: [email protected].

PMID: 39537034
DOI: 10.1016/j.jinf.2024.106349

Abstract

Objective: To describe an outbreak due to Candida vulturna, a newly emerging Candida species belonging to the Candida haemulonii species complex in the Metschnikowiaceae family.

Methods: In this retrospective cohort study we genotyped 14C. vulturna bloodstream isolates, occurring in a 4-month-period in paediatric cancer patients in a Brazilian hospital. To prove an outbreak, ITS sequence analysis and whole genome sequencing (WGS) was done. Antifungal susceptibility was performed with the reference CLSI method and the commercial Sensititre YeastOne (SYO) YO10 plates. A control C. vulturna isolate from another region in Brazil was included in all analyses.

Results: MALDI-TOF-MS identified isolates as C. pseudohaemulonii and C. duobushaemulonii albeit with low scores and therefore molecular methods were required for accurate identification. ITS sequence analyses clearly differentiated C. vulturna from other species in the C. haemulonii species complex. WGS proved the presence of a clonal outbreak with C. vulturna involving 14 paediatric patients. Antifungal susceptibility testing (AFST) with two methods showed the isolates had low MICs of commonly available antifungals.

Conclusion: This study describes an outbreak due to the rare yeast C. vulturna, related to C. auris, during a four-month period in patients admitted to a paediatric oncology ward in a Brazilian hospital. In contrast to previous studies the yeast was susceptible to all antifungals and patient outcome was good.

Keywords: Candida haemulonii species complex; Candida vulturna; antifungal susceptibility; fungal outbreak; genotyping; rare yeast; whole genome sequencing.